{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T23:38:49Z","timestamp":1789515529158,"version":"build-2803163510"},"reference-count":12,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2023,3,3]],"date-time":"2023-03-03T00:00:00Z","timestamp":1677801600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl J Gynecology &amp; Obste"],"published-print":{"date-parts":[[2023,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>The first trimester combined risk of trisomy 21 is obtained by multiplying the risk related to maternal age by the likelihood ratios of nuchal translucency, free beta\u2010human chorionic gonadotrophin (\u03b2\u2010hCG) and placenta associated plasma protein\u2010A. Beyond five multiples of the median (MoM) of \u03b2\u2010hCG, the risk of trisomy 21 is truncated. The objective of the present study was to evaluate the evolution of the first trimester combined risk of trisomy 21 in individuals with first\u2010trimester free\u2010\u03b2\u2010hCG levels between 5 and 10 MoM.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a non\u2010interventional cohort study from a 6\u2010year database of combined first\u2010trimester trisomy 21 screening of all individuals who underwent the screening in a French specialized medical analysis center. We included all pregnant individuals who had a serum\u2010free \u03b2\u2010hCG between 5 and 10 MoM. Patients for whom the status of the fetus, with or without trisomy 21, was not identified by the outcome of the pregnancy or by a karyotype result were excluded from the study. The discriminatory capacity of free\u2010\u03b2\u2010hCG above 5 MoM was studied by a receiver operating characteristic curve. We used an orthogonal polynomial regression to represent the evolution of likelihood ratios according to free\u2010\u03b2\u2010hCG in MoM.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 413\u2009216 combined first\u2010trimester screens of trisomy 21, 2239 (0.5%) screens met the inclusion criteria. In the selected population, 801 (35.8%) were excluded from the study because of missing fetal or neonatal status, and 46 (3.2%) fetuses out of 1438 included were diagnosed with trisomy 21. For free <jats:styled-content style=\"fixed-case\">\u03b2\u2010hCG<\/jats:styled-content> values between 5 and 10 <jats:styled-content style=\"fixed-case\">MoM<\/jats:styled-content>, the area under the curve is 0.56 (0.46\u20130.65). The scatterplot of the likelihood ratio of <jats:styled-content style=\"fixed-case\">\u03b2\u2010hCG<\/jats:styled-content> showed an increasing parabolic pattern: the likelihood of trisomy 21 increases with the <jats:styled-content style=\"fixed-case\">free\u2010\u03b2\u2010hCG<\/jats:styled-content> threshold.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>To override the truncated risk of trisomy 21 in case of free \u03b2\u2010hCG values between 5 and 10 MoM, the study has allowed us to estimate the adjusted risk of trisomy 21, enabling health professionals to offer appropriate prenatal counseling.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ijgo.14722","type":"journal-article","created":{"date-parts":[[2023,2,10]],"date-time":"2023-02-10T10:12:33Z","timestamp":1676023953000},"page":"676-683","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Combined first trimester screening for trisomy 21: Assessment of excess risk in case of free \u00df\u2010human chorionic gonadotrophin between 5 and 10 multiples of the median"],"prefix":"10.1002","volume":"162","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4805-2083","authenticated-orcid":false,"given":"Anthony","family":"Atallah","sequence":"first","affiliation":[{"name":"Department of Maternal\u2010Fetal Medicine and Obstetric Emergency Department, Groupement Hospitalier Est Hospices Civils de Lyon, H\u00f4pital Femme M\u00e8re Enfant  Bron France"},{"name":"Claude Bernard University Lyon 1  Lyon France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H\u00e9l\u00e8ne","family":"Leport","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Centre Hospitalier de Bourg en Bresse  Bourg\u2010en\u2010Bresse France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Corinne","family":"Sault","sequence":"additional","affiliation":[{"name":"Eurofins\u2010Biomnis Laboratory  Lyon France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benoit","family":"De La Fourni\u00e8re","sequence":"additional","affiliation":[{"name":"Claude Bernard University Lyon 1  Lyon France"},{"name":"Department of Obstetrics and Gynecology Hospices Civils de Lyon, Croix Rousse University Hospital  Lyon France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cyril","family":"Huissoud","sequence":"additional","affiliation":[{"name":"Department of Maternal\u2010Fetal Medicine and Obstetric Emergency Department, Groupement Hospitalier Est Hospices Civils de Lyon, H\u00f4pital Femme M\u00e8re Enfant  Bron France"},{"name":"Claude Bernard University Lyon 1  Lyon France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marion","family":"Cortet","sequence":"additional","affiliation":[{"name":"Claude Bernard University Lyon 1  Lyon France"},{"name":"Department of Obstetrics and Gynecology Hospices Civils de Lyon, Croix Rousse University Hospital  Lyon France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,3,3]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jgyn.2014.05.012"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/pd.2347"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1469-0705.1999.13040231.x"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/pd.2637"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1258\/096914107781261873"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1177\/0969141318783021"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1469-0705.1998.12010008.x"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.5468\/ogs.2018.61.4.453"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gofs.2017.11.002"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0016672319000119"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.3390\/e23020186"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1258\/0969141054855283"}],"container-title":["International Journal of Gynecology &amp; 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